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- Title
A comparison of two methods to perform a breathing trial before extubation in pediatric intensive care patients.
- Authors
Farias, J.; Retta, A.; Alía, I.; Olazarri, F.; Esteban, A.; Golubicki, A.; Allende, D.; Maliarchuk, O.; Peltzer, C.; Ratto, M.; Zalazar, R.; Garea, M.; Moreno, E.; Farias, J A; Alía, I; Ratto, M E; Moreno, E G
- Abstract
<bold>Objective: </bold>To compare the percentage of infants and children successfully extubated after a trial of breathing performed with either pressure support or T-piece.<bold>Design: </bold>Prospective and randomized study.<bold>Setting: </bold>Three medical-surgical pediatric intensive care units (PICUs).<bold>Patients: </bold>Two hundred fifty-seven consecutive infants and children who received mechanical ventilation for at least 48 h and were deemed ready to undergo a breathing trial by their primary physician.<bold>Interventions: </bold>Patients were randomly assigned to undergo a trial of breathing in one of two ways: pressure support of 10 cmH2O or T-piece. Bedside measurements of respiratory function were obtained immediately before discontinuation of mechanical ventilation and within the first 5 min of breathing through a T-piece. The primary physicians were unaware of those measurements, and the decision to extubate a patient at the end of the breathing trial was made by them.<bold>Measurements and Main Results: </bold>Of the 125 patients in the pressure support group, 99 (79.2%) completed the breathing trial and were extubated, but 15 of them (15.1%) required reintubation within 48 h. Of the 132 patients in the T-piece group, 102 (77.5%) completed the breathing trial and were extubated, but 13 of them (12.7%) required reintubation within 48 h. The percentage of patients who remained extubated for 48 h after the breathing trial did not differ in the pressure support and T-piece groups (67.2% versus 67.4%, p=0.97).<bold>Conclusions: </bold>In infants and children mechanically ventilated, successful extubation was achieved equally effectively after a first breathing trial performed with pressure support of 10 cmH2O or a T-piece.
- Subjects
PEDIATRIC intensive care; CRITICAL care medicine; PEDIATRIC emergencies; ARTIFICIAL respiration; PEDIATRICS; RESPIRATION; LUNG disease treatment; RESPIRATORY insufficiency treatment; AGE distribution; BLOOD gases analysis; CLINICAL trials; COMPARATIVE studies; LENGTH of stay in hospitals; LONGITUDINAL method; LUNG diseases; RESEARCH methodology; MEDICAL cooperation; RESEARCH; RESPIRATORY measurements; RESPIRATORY insufficiency; STATISTICAL sampling; EVALUATION research; MECHANICAL ventilators; RANDOMIZED controlled trials; TREATMENT effectiveness; SEVERITY of illness index; HOSPITAL mortality; POSITIVE end-expiratory pressure; EQUIPMENT &; supplies
- Publication
Intensive Care Medicine, 2001, Vol 27, Issue 10, p1649
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/S001340101035